No pill can cure poverty. This is an old truth but one that needs repeating. Again and again. An article in the prestigious American Journal of Public Health (reprints can be ordered at the journal’s website) reminds me of this need. Three co-authors with Ph.D.s, two of whom have nursing experience, have published a “Field Action Report” assessing the affect of the formation of fathers’ clubs on child health in rural Haiti.
The article summary reports the key findings:
“The presence of a fathers’ club in a child’s birth village had a positive effect on vaccination status, growth monitoring and vitamin A supplementation after we controlled for socioeconomic status, time and the quality of the village health agent. Child weights and mortality were not affected by the fathers’ clubs.”
That pretty much says it all, but let’s break it down.
The study is based on detailed and extensive individual and household-level data gathered by the Haitian Health Foundation (HHF). The HHF was established in 1985 and is now operating in 104 villages in southwestern Haiti. The HHF instituted fathers’ clubs in 1994 in response to the discovery that fathers play an important role in child care in this region.
The clubs were meant to enhance child health and welfare. The fathers meet regularly to learn about child and family health from a nurse or village health agent. Education focuses on the 12 key family and community practices identified by the World Health Organization and UNICEF. The model outlines three pathways through which child health should improve.
Focusing on data from 23 villages with fathers’ clubs, the authors used children born before the clubs were established as the control group and children born afterwards as the “intervention group.” While not ideal, this approach is scientifically acceptable.
The presence of fathers’ clubs is associated with children aged one to two years being vaccinated, having their growth measured and taking vitamin A supplements. Here is what the authors say about this finding:
“Actual weights of children and infant mortality — measures that are arguably more important than the more proximal outcomes of growth monitoring, vaccinations and vitamin A supplementation — did not improve with the intervention. Furthermore, child weights remained flat over the years of study. Malnutrition is still a major problem in Haiti and continues to contribute to high morbidity and mortality in the first year of life. Malnutrition appears resistant to HHF efforts and is instead affected by factors well beyond the scope of a public health services program such as the underlying conditions of economic deprivation in rural Haiti and the political upheaval that has endured in Haiti for many years.”
I don’t need to remind you that the article under discussion was written before the earthquakes of January 2010.
So what to do? The authors mention the WHO recommendation to educate parents about feeding supplements for infants through 24 months. But they note, “This recommendation may not be feasible, given the economic constraints …. Further research is needed to develop programs that can be successful within these constraints.”
“Constraints” indeed. The kind of “constraints” that prevent the usual well-meaning educational interventions to work. At all.
How would you feel if you had a malnourished baby and no money, and someone tried to educate you about the importance of providing more food for your baby?
You might, as I was, be surprised to read the upbeat concluding paragraph:
“In conclusion, fathers’ clubs appear to be an effective strategy in child health programs. The success of fathers’ clubs in Haiti may encourage other global efforts to include fathers in a wide range of child health programs that use a community-based participatory approach.”
What? An “effective strategy” if your goals are limited to increasing the rate vaccinations, growth monitoring and vitamin A intake. But for improving children’s health? No success at all.
I’m all for fathers’ clubs. They may work in ways that this study overlooks: social support for parents (notably fathers) through the regular meetings. But they are not going to put food in the mouths of Haitian babies.
Source: Elizabeth Sloand, Nan Marie Astone, and Bette Gebrian. 2010. The Impact of Fathers’ Clubs on Child Health in Rural Haiti. American Journal of Public Health 100(2):201-204.
Image credit: Flickr user shouldbecleaning, licensed by Creative Commons.
anthropologyworks 
HHF gave me housing in Haiti (in lovely Jeremie) when I was there trying to figure out what I wanted to do in 1988. They do great work. Their public health director, Bette (not sure of her real title there), has been working in that area for well over 20 years. I haven’t read the article, but it would be surprising to find an intervention that has an impact on every outcome you examine (WIC, school meals and the Food Stamp Program in the US have similar problems; controlling for contextual factors is hard, as you point out). If it helps some outcomes, and it looks like it helps those under most immediate control: the use of supplements and vaccinations, that’s not bad at all. No?
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Dr. Miller,
The basis of engaging fathers in family health affairs was based on the PhD anthro dissertation by Robin Devin (Uconn)- Mothers work and child health 1994…where, among other things, she documented the realtionship between fathers knowledge of foods for children (yams not eggs or bean sauce) and malnutriton. We then deviated from the usual engagement of father for family olanning and invited men (including young men and elders) to come together. Since 1995 we have worked with men (although they are not as regular as women in the mother clubs) on their relationship with their (and village) children. While not evident in Dr. Sloand’s work, the empirical evidence of fathers bringing children to village heatlth workers or clinic for diagnosis and treatment of bacterial pneumonia has played a part in the reduction of deaths from this illness by 50% (CDC 1998). Men “compete” with women to “win” in the knowledge area on family health….success breeds success and we have seen some pretty extraordinary efforts. Others have replicated this model of engagement of fathers which is fairly unusual in rural Haiti. It is encouraging to see the boys we registered in the public health program in 1988 step up to the plate, so to speak, and take a load off the women. Thank you for your comments, they are helpful.Bette Gebrian RN MPH PhD
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Dear Bette (if I may), I very much appreciate your insightful comments about the role of fathers/husbands/men in family health. Thank you for sharing knowledge from the field that can help move projects/programs forward.
Barbara
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